You will need to sign on with your LLLID (La Leche League ID) before you can post. If you have never claimed your LLLID, create your LLLID now. To sign in, click the LLLID Sign On button in the upper right corner. Enter your LLLID Alias and click the button again.

I need some advice! Foremilk/hindmilk inbalance.

Hi y'all! I'm new on here so I'm sorry, I'm still trying to get used to this whole forum thing. First off, I'd like to say how grateful I am to have a venue where I can express concerns an receive some feedback from real moms with real experience!

Now here's my issue. I'm a new mom to a 4 month old baby girl, I EBF and as of right now I plan on doing it for as long as my baby girl wants to! BUT, just about an hour ago or so I changed my daughter's diaper, here comes the TMI, well in the diaper I noticed flecks of black stuff that looked like black pepper in her poop. When I looked online to see what this could be it all led to blood in the stool! This obviously terrified that life out of me! Now, I haven't eaten anything stranger or different, the milk I use is lactose free since my husband is lactose intolerant, so I don't believe it's a food allergy. Then I read on one of the LLL posts that it's more likely than not a foremilk/hindmilk inbalance.

Here's a little background info: I've been taking fenugreek to help with my supply seeing as I was kind of lacking before, so I've been taking it since she was about 2-3 weeks old. Only 2 pills a day! But the last week or so I decided to take more, 3 pills 2-3 times a day because my little piggy eats very 90 minutes!! The issue is that she only nurses for about 5 minutes at a time, no matter if it's quiet or TV on she latches and unlatches a ton after about 4 minutes, kind of like it's a game! She'll suck on her thumb, smile, and go back down to nursing for like 10 seconds an repeats the cycle, only at night for bedtime does she not do that. I wouldn't think this to be a problem if I hadn't found the blood in her stool. She's also been kind of cranky, ok maybe a little bit more than a little! She had a couple of days where she would scream at the top of her lungs for no reason when she started nursing, which had led me to think that her tummy hurts. I've decided to lower my intake of fenugreek back down to 2 pills a day and hopefully that will help slow down my supply back to a more normal and manageable amount for her. My poor baby girl!

Alrighty, now that I've bored y'all half to death I'll ask my questions! I suppose what I'm asking is how I can get her to nurse for longer than 5 minutes. I'm going to assume that in those 5 minutes she's getting more foremilk (because I'm producing so much) which is causing the pain and potentially the blood in the stool and not keeping her as full. She takes such short naps these days and wakes up about every 2 hours at night still. She's sharing a bed with us because if not I would never rest!!

I'm so sorry this is so darn long ladies, I just don't want my baby in pain anymore and I'd like her to be satisfied for longer, she just won't start on the boob long enough!

Re: I need some advice! Foremilk/hindmilk inbalance.

was this one poop with black flecks? Any other signs of anything being amiss? Sometimes blood just happens, and if it's black, that would indicate really old blood, wouldn't it? I don't know, actually, I am asking! ...anyway, definitely something to keep an eye on, but nothing to freak out about yet.

A couple more thoughts: When a baby has issues with dairy via breastmilk, it is not lactose that is the problem. It is dairy protein. So lactose or not, dairy needs to be eliminated or cut back from from moms diet when this is a problem. The good news is, it is a very rare problem. If your only issue is this one time of maybe blood, I would not suggest diet changes.

Fenugreek has been reported by moms as causing gastrointestinal discomfort in moms and babies. So, I would look at the fenugreek use. It sonds as if you may have never needed fenugreek. Most mothers make plenty of milk for thier babies without needing herbs. But many moms do fear they do not make enough, usually, this is not the case. What convinced you that your supply was lacking in the first place? What convinced you that you needed to up the fenugreek recently?

Your babies behavior at the breast-the on and off stuff- is normal. 4 month olds nurse this way quite a bit. if the problem really is overproduction, you could let baby stay on one side through 2 or more of these short 'sessions.'

Re: I need some advice! Foremilk/hindmilk inbalance.

ok i poked around some more. according to some sources, blood looking black suggests the blood spent time in the tummy. So. was ingested or came from further up the chain. Have you had any cracks or bleeding on you nipples? Was baby recently ill and actually vomiting?

Re: I need some advice! Foremilk/hindmilk inbalance.

She so far has pooped twice with flecks of blood, I believe she's working on time number three.... All in one day! I don't have any cracks in my nipples, haven't since the first couple of weeks. I decided to take fenugreek because I didn't think I was producing enough, not because someone told me so (her pediatrician LOVES that I EBF!), she was just always hungry and it didn't seem like I was. I've always taken much less than recommended and we've NEVER has any tummy issues because of it, I'm truthfully convinced that it's because I upped my dose. Which I did because she's ravenous these days! Except I didn't think anything of taking a normal dose of fenugreek until today! She was even sleeping more at night before I took more, so I'm pretty much convinced to just stop it for a while then go back to just 2 pills a day, if I do to back on it! She's just been kinda crabby so I'm thinking it's tummy pains! She has her 4 month check up on Tuesday, I just wanted to know how I can start helping her now. But I'd still like to know how to keep her eating for a big longer so it's not all foremilk, she needs the more fatty milk!

Re: I need some advice! Foremilk/hindmilk inbalance.

You did not answer my question about weight gain so I am going to assume weight gain is good. If it is not, that is a different situation entirely.

Assuming good weight gain, The problem is not really that a baby is not getting enough hindmilk. The problem is too much foremik. If there is an issue with baby having a lactose reaction to too much foremilk, it is almost surely due to forceful letdown, the other factor being mom limiting feeding frequency or switching sides during each feeding, but this is all related. It is forceful letdown and/or oversupply that MAY cause these issues. Do you experience any other symptoms of these, according to the kellymom article? If you do, you can try the ideas in the kellymom article and probably stop fenugreek entirely, because you certainly do not need it if you have oversupply. Maybe wean off it gradually? I don't know how that part of it works.

Assuming good weight gain, short feedings that are frequent are entirely normal and not a problem. It is a long length between feedings that can cause a problem sometimes where baby is getting "too much" foremilk, and since baby is nursing frequently, that does not sounds like your experience. But, in any case, again I suggest, to help baby get less foremilk and thus, more hindmilk, try letting let baby nurse on the same side when baby keeps pooping off. Don't switch sides so often, basically.

Galactagogues, when they work for a particular mom, increase milk production. For a mom who has low milk production, which would be suspected if an ebf baby was gaining poorly, they can assist in making more or enough milk. For a mom with normal milk production, they can cause overproduction and their use is thus not only unneeded, but potentially harmful.

Re: I need some advice! Foremilk/hindmilk inbalance.

Welcome to the forum! Based on what you've written, I see absolutely no reason to freak out. Yes, I know (from experience!) that seeing blood in your baby's diaper is one of those moments that sends a mom into panic mode. But when a baby is growing and developing normally, a few bloody specks are nothing to worry about.

There are a lot of different ways to get blood into a baby's diaper. One of the most common is blood from mom's breast/nipple. It's pretty common for mom to have small blood vessels break during nursing or pumping. The blood vessels tend to break painlessly, so a mom who is pumping may not realize that she's had one until she looks down and sees a bottle of shocking pink milk, and many nursing moms never realize that they've had a broken blood vessel unless the baby spits up some blood or poops it out.

Aother common source of blood in poop is a small tear in the rectum or anus- blood from these sources tends to be bright red.

Bloody poops can be caused by intestinal irritation from illness, oversupply, or allergies. Allergies are relatively rare, and IMO you don't really want to go there unless you're seeing additional symptoms of allergy, like excema, hives or other rashes, or breathing difficulties. Oversupply, on the other hand, is really common, and it sounds like it could a pretty good match for you, because your baby feeds rapidly, unlatches frequently, and sometimes screams when she starts nursing. All those behaviors are common in babies dealing with fast letdowns from oversupply. When a baby is having issues with oversupply, what is happening is that she is getting so much lactose-rich milk that the lactose is overwhelming the amount of lactase enzyme her gut is producing. Too much lactose + not enough lactase = difficulties with gassiness and intestinal irritation, and again, intestinal irritation can cause blood in the stool.

Are you freaking out about your baby maybe being lactose intolerant yet? If not, good! Because you shouldn't be. Babies excel at producing lactase, the enzyme that breaks the complicated lactose molecule down into the more digestible sugars glucose and galactose. Babies are designed to digest lactose because human milk is naturally full of it. Lactose intolerance is almost exclusively a condition that develops with age, because almost all mammals (with the exception of some humans) lose the ability to produce a lot of lactase as they get older. Your husband was almost surely not lactose intolerant as a baby, but became so as he got older.

One nice thing about lactose is that YOU can have as much as your gut will handle without worrying that you're going to create lactose-enriched milk with which to torment your baby. When a baby has an allergy to dairy in mom's diet, the problem is not the sugar (lactose) but the protein (casein).

It sounds like you're really worried about the whole "foremilk/hindmilk" thing. But unless your baby is severely uncomfortable and having consistently green and bloody poops, your probably don't have to be. A baby can grow and thrive on so-called "foremilk" alone, provided she gets enough of it. This is because foremilk contains everything a baby needs to grow and thrive- all the fat, all the protein, all the fat-soluble elements. In fact, babies whose moms have oversupply tend to grow more rapidly than moms with average supply, even though their babies consume mostly foremilk. Another thing to remember is that moms don't produce 2 discrete types of milk (i.e. foremilk and hindmilk); they only produced milk. Relatively watery and rich in carbohydrates at the beginning of the feeding when the breast is full, increasingly higher in fat as the breast empties.

More time at the breast and more "hindmilk" are not a ticket to longer intervals between feedings or a more "satisfied" baby. Nursing every 90 minutes or so is totally normal for such a young baby!

Re: I need some advice! Foremilk/hindmilk inbalance.

Her weight is absolutely fine last time we went to her pediatrician, she was in the 54th percentile. She has another appointment tomorrow so I suppose we'll see then how she's progressing.

She has about 4 BM with flecks of blood and then she was acting like she felt a lot better, less cranky. I only took two fenugreek and I put her in a parallel position to me while nursing, she stayed on for longer. I'm not trying to get her to eat less often but just to be full the entire time rather than cranky cause she wasn't actually full. She's just in that state where she gets very easily distracted!